If passed, Issue 3 will amend the Ohio Constitution to include the following language:

“In Ohio, no law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in a health care system. In Ohio, no law or rule shall prohibit the purchase or sale of health care or health insurance. In Ohio, no law or rule shall impose a penalty or fine for the sale or purchase of health care or health insurance.”

To provide an understanding of the potential implications of Issue 3, HPIO has included analysis from:

Maurice Thompson, Executive Director of the 1851 Center for Constitutional Law

Janetta King, President of Innovation Ohio

“The purpose of the Health Policy Institute of Ohio is to provide state policymakers with the information and analysis they need to make informed health policy,” said HPIO President Amy Rohling McGee. “In the case of a ballot initiative, the voters are the policymakers and given that Issue 3 is a health policy issue, we wanted to make unbiased information and analysis accessible to Ohio voters.”

The Kaiser Family Foundation report released earlier this week that found that health insurance premiums rose 9 percent from 2010 to 2011 has stirred debate about the impact of federal reform on insurance costs, but analysts from the Commonwealth Fund have concluded that ACA provisions played a small part in the increase (Source: “Understanding the Rise in Health Insurance Premiums,” Commonwealth Fund Blog, Sept. 30, 2011).

While some have attributed the spike to passage of the ACA, the Commonwealth researchers attribute only 1.8 percentage points of the 8 to 9 percent increase to health reform provisions. The remainder of the increase is attributed to issues such as the cost of medical technology, overall inflation and an aging population.

“Moreover, this marginal increase as a result of the reforms also means that families have better coverage that protects them from catastrophic health care costs as well as lower out-of-pocket costs for preventive services like colonoscopies and mammograms,” write study authors Jon R. Gabel of the National Opinion Research Center, and Roland McDevitt and Ryan Lore of the consulting firm Towers Watson. “It’s logical that improvements in the quality of the product would increase the cost of premiums and lower out-of-pocket costs to some degree.”

On Wednesday the Obama administration formally asked the Supreme Court to review the Affordable Care Act, a move that likely means a ruling will be issued by next June (Source: “High court asked to review health-care law,” McClatchy Newspapers via Columbus Dispatch, Sept. 29, 2011).

There are several cases winding their way through the court system, but the Justice Department chose to appeal a recent 11th Circuit Court of Appeals ruling that the individual mandate is unconstitutional.

“The department has consistently and successfully defended this law in several court of appeals, and only the 11th Circuit Court of Appeals has ruled it unconstitutional,” the Justice Department said in a written statement. “We believe the question is appropriate for review by the Supreme Court.”

The Ohio State Medical Association said this week that passage of legislation currently being considered in the Ohio Senate would streamline patient care for doctors in the state (Source: “OSMA director: Health insurance law would aid doctors,” Lawrence Eagle-Gazette, Sept. 30, 2011).

Among the provisions of Senate Bill 136, which is know as the Health Insurance Modernization Act, are ones that would make prior authorization for physicians from insuance companies more transparent and decrease the time insurance companies must pay doctors from 30 to 15 days.

September 23, 2011

A report released this week by the Ohio Department of Insurance projects that after the full implementation of the ACA, prices for individual insurance policies could increase 55 to 85 percent, while small group plans could cost 5 to 15 percent more and large group plan costs could increase 3 to 5 percent (Source: “Insurance premiums expected to increase, report says,” Columbus Dispatch, Sept. 20, 2011).

According to the report from health care consultant Milliman Inc.(pdf, 69 pages), the cost increase is “primarily driven by the estimated health status of the new individual health insurance market and the expansion of covered benefits. Current insured benefit expenses in the individual market are approximately 40% less than the (employer-sponsored insurance)-small group market. This is attributable to today's individual market having leaner covered benefits, such as the exclusion of maternity services, and a lower-cost population relative to the ESI markets.”

In a statement released by her office, Lt. Gov. and Department of Insurance Director Mary Taylor said “This report clearly shows what I have long predicted: Obamacare will result in bigger government, unsustainable costs and ultimately, less consumer choice.”

The $4,091,507 given to Ohio is part of $250 million allotted to states so that they can enforce the Affordable Care Act requirement, which went into effect on Sept. 1, that health insurers seek approval and publically justify increasing rates by 10 percent or more in the individual and small group market.

According to the HHS release, Ohio is proposing to use the grant funds in the following ways:

Hire additional staff to review filings in a more comprehensive manner, with all forms and rates in a single filing. Analysts will also conduct market conduct reviews to make certain rates are calculated according to the filing rules.

Upgrade its internal IT system to develop a consumer-friendly web application to assist Ohio residents in using product and pricing information.

Create 3 new positions with Cycle II grant funding; these positions are in addition to the 5 positions created with Cycle I funds.

Create a rate and policy database to conform rate review with reporting requirements to help synchronize internal data with that published to the public on the Federal web portal

New Census Bureau data, as well as other new surveys released this week, shows that young adults have gained health coverage at higher-than-expected rates since the ACA was passed in 2010 (Source: “Young Adults Make Gains in Health Insurance Coverage,” New York Times, Sept. 21, 2011).

According to a report from the Census Bureau(pdf, 87 pages), the share of young adults – the group most likely to be uninsured – without health insurance dropped in 2010 by 2 percentage points, to 27.2 percent. That decline meant that 502,000 fewer 18- to 24-year-olds were uninsured. Most gained coverage through private policies, not government programs.

The Obama administration attributes the improvement to a provision of the Affordable Care Act that permits parents to cover dependents up to their 26th birthdays. Until that measure took effect one year ago this week, children typically had to roll off their parents’ family policies at 18 or 21, or when they left college.

A gathering of the 46 states that have received federal grants to develop insurance exchanges led to little clarity on the details of a federally run exchange or a hybrid state-federal model (Source: “States still unclear on health insurance exchanges,” Reuters, Sept. 20, 2011).

"I haven't learned anything new about what the federal exchange would look like," said one state insurance official who attended the meeting that was closed to reporters.

Last week the Health Policy Institute of Ohio released a policy brief: Federal rules for establishing health insurance exchanges (pdf, 12 pages). The brief outlines key choices Ohio will have to make on exchanges, what other states are doing, and summarizes the proposed rules on exchanges –- highlighting key issues and considerations regarding establishment of an Ohio exchange.

Health insurance exchanges sit at the cornerstone of federal health reform and are aimed at providing affordable health care coverage to individuals and small businesses. In recent weeks, there has been a great deal of attention given to the proposed rules providing guidance on establishment of exchanges and the reinsurance, risk corridor, and risk adjustment mechanisms related to coverage sold through exchanges.

HPIO’s brief outlines key choices Ohio will have to make on exchanges, what other states are doing, and summarizes the proposed rules on exchanges – highlighting key issues and considerations regarding establishment of an Ohio exchange.

According to the Ohio scorecard, the state ranks highest in in “support for family caregivers (23rd) and “choice of setting & provider” (26th). Minnesota was ranked first in the report and Alabama ranked last.

According to the report, if Ohio improved to the level of the best-performing state:

29,182 more low- or moderate-income adults age 21 and older with activity of daily living disabilities would be covered by Medicaid.

14,000 more new users of Medicaid LTSS would first receive services in home and community based settings instead of nursing homes.

6,431 nursing home residents with low care needs would instead be able to receive LTSS in the community.

5,682 unnecessary hospitalizations of people in nursing homes would be avoided.